Abstract
BackgroundThe high burden of bereavement in sub-Saharan Africa is largely attributable to HIV, cancer, and other non-communicable diseases. However, interventions to improve grief and bereavement are rare. Given high rates of mortality in the context of weak health systems, community lay members are well placed to provide peer bereavement support. The 9-cell bereavement tool was developed in Zimbabwe to improve community members’ capacity to support the bereaved. This study aims to determine the feasibility of implementing the 9-cell bereavement tool and recruitment to experimental evaluation.Methods/designThis feasibility cluster randomized trial with embedded qualitative interviews will be conducted in two comparable neighborhoods in Zimbabwe. Community leaders from each neighborhood will identify 25 potential community lay bereavement supporters, each of whom will recruit 2–3 bereaved community members into the trial. The intervention will be randomly allocated to one community, and the second community will form a wait-list control (n ≥ 75 in each community cluster). Recruitment is estimated to take place over 3 weeks. Measures at T0 (baseline, i.e., week 0), T1 (midline, i.e., week 14 or 3 months post-baseline) and T2 (endline, i.e., week 27 or 3 months post-midline) will address mental health, social support, and levels of grief per individual. Qualitative data will describe lay supporters’ views of intervention training and delivery, and participants’ experience of bereavement support.DiscussionThis is the first documented trial evaluating a bereavement intervention in sub-Saharan Africa. Recruitment, retention, and measurement data will determine the feasibility of a full trial.Trial registrationISRCTN, ISRCTN16484746. Registered 6 February 2018
Highlights
The high burden of bereavement in sub-Saharan Africa is largely attributable to Human immunodeficiency virus (HIV), cancer, and other non-communicable diseases
The World Health Organization (WHO) Global Palliative Care Atlas, the Lancet Commission on Pain and Palliative Care [11], and the World Health Resolution on Palliative Care [12] have all identified a critical gap between the need for, and provision of, palliative care
Feasibility questions and success criteria We will seek to answer the following research questions: (1) will we be able to recruit at least 75% of the suggested sample size of interventionists and trial participants interventionists within 3 weeks? In order to meet proposed trial timelines, we suggest trial recruitment criteria of recruiting community leaders within 1 week; interventionists within 1 week and the trial participants within 1 week; giving a total recruitment period of 3 weeks
Summary
The high burden of bereavement in sub-Saharan Africa is largely attributable to HIV, cancer, and other non-communicable diseases. Bereaved individuals who have not been through the process of grief have an increased risk of mortality [2, 3], deterioration of physical health [2], reduced cognitive functioning, increase in mental health challenges, and associated illnesses [4]. These outcomes negatively impact the socio-economic status of individuals while generating high costs in already fragile economies of low-income countries [5, 6]. Systematic reviews of the evidence in sub-Saharan Africa have found that bereavement interventions are rarely described within palliative care intervention studies [13, 14]
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